中药降糖增敏汤治疗老年2型糖尿病胰岛素抵抗（脾虚湿盛证）的临床研究

发布时间：2018-08-26 10:49

【摘要】：目的:在中医学辨证论治理论的指导下,探讨中药复方制剂降糖增敏汤联合二甲双胍片对老年2型糖尿病胰岛素抵抗(脾虚湿盛证)的治疗作用,并对降糖增敏汤的配伍特点及药理作用机制进行初步探讨。方法:于我院保健科住院患者中选取符合标准的老年2型糖尿病胰岛素抵抗(脾虚湿盛证)患者65例,随机分为治疗组32例,对照组33例。两组患者均给予糖尿病基础规范治疗(医学营养饮食、运动、血糖监测和糖尿病教育),对照组给予西药二甲双胍片口服,治疗组在口服二甲双胍片的同时加用自拟中药降糖增敏汤治疗。以4周为1个疗程,共治疗3个疗程。治疗前后分别测定患者血糖、空腹胰岛素、血脂、血流变、C反应蛋白,计算胰岛素抵抗指数、胰岛素敏感指数、胰岛素β细胞功能指数、体重指数,并观察两组治疗前后中医症状积分的改变情况。所得数据分别采用t检验、X2检验及秩和检验进行统计分析。结果:经过3个疗程的治疗,治疗组总有效率为86.67%,对照组总有效率为66.67%,治疗组患者血糖、血脂、血流变及空腹胰岛素、C反应蛋白指标值较治疗前均明显改善,与治疗前相比结果有极显著性差异(P0.01),且疗效优于对照组(P0.05或P0.01)。治疗后治疗组患者胰岛素抵抗指数较前降低,胰岛素敏感指数明显提高,组内比较有极显著性差异(P0.01),且疗效优于对照组(P0.01);治疗后治疗组患者胰岛β细胞功能指数较治疗前明显升高,组内比较有极显著性差异(P0.01),但与对照组疗效相当(P0.05)。结论:中药降糖增敏汤在二甲双胍片疗效基础上可显著改善老年2型糖尿病胰岛素抵抗(脾虚湿盛证)患者的糖脂代谢、血液粘稠度及炎症状态,提高胰岛素敏感性,改善胰岛素抵抗状态,疗效确切;但在改善胰岛β细胞功能方面无明显优势。
[Abstract]:Objective: to explore the therapeutic effect of Jiangtang Zengmin decoction combined with metformin tablet on insulin resistance (spleen deficiency and dampness syndrome) in elderly type 2 diabetes mellitus under the guidance of TCM theory of syndrome differentiation and treatment. The compatibility characteristics and pharmacological mechanism of Jiangtang Zengmin decoction were discussed. Methods: 65 elderly type 2 diabetic patients with insulin resistance (spleen deficiency and dampness syndrome) were randomly divided into treatment group (n = 32) and control group (n = 33). The patients in both groups were given basic standard treatment for diabetes (medical nutrition diet, exercise, blood glucose monitoring and diabetes education), while the control group was given metformin tablets orally. The treatment group was treated with Jiangtang Zengmin decoction at the same time as metformin tablets. 4 weeks as a course of treatment, a total of 3 courses of treatment. Blood glucose, fasting insulin, blood lipid, hemorheological C-reactive protein, insulin resistance index, insulin sensitivity index, insulin 尾 cell function index, body mass index were measured before and after treatment. The changes of TCM symptom score before and after treatment were observed. The data were analyzed by t test X 2 test and rank sum test respectively. Results: after three courses of treatment, the total effective rate was 86.67 in the treatment group and 66.67 in the control group. The blood glucose, blood lipid, blood rheology and fasting insulin C-reactive protein index were significantly improved in the treatment group. Compared with the results before treatment, there was a significant difference (P0.01), and the curative effect was better than the control group (P0.05 or P0.01). After treatment, the insulin resistance index of the patients in the treatment group was lower than that of the former, and the insulin sensitivity index was obviously increased. Compared with the control group (P0.01), the islet 尾 cell function index in the treatment group was significantly higher than that before treatment (P0.01), but the curative effect was similar to that in the control group (P0.05). Conclusion: Jiangtang Zengmin decoction can significantly improve glucose and lipid metabolism, blood viscosity and inflammatory state in elderly type 2 diabetes mellitus patients with insulin resistance (spleen deficiency and dampness syndrome) on the basis of metformin tablets, and improve insulin sensitivity. The effect of improving insulin resistance is definite, but there is no obvious advantage in improving the function of islet 尾-cells.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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